Deleted

Adam Smith liked it quiet while he was doing his documentation. It seemed wherever
or whenever he logged on someone would sit down next to him and want to chat, show
him a funny cat video, or consult on a case. The constant interruptions were making
internship difficult and the days long. He longed for a quiet space and an open desktop.
He had searched the hospital, from obscure office spaces to darkened hallway terminals,
but every time he found an isolated spot and began to write an admission history and
physical or a daily progress note, he would find someone at his elbow. His resident
had no advice, and his co-intern on the service was useless. Every day his frustration
grew.

Illustration by David Rosenman

One night on call, Adam tried searching in a closed unit. He traveled down a flight
of stairs into an old office space. There, on a dusty wooden desk, was an old PC.
He thought it wouldn't work, but when he typed his user name and password, it slowly
came to life, with an odd blue-tinged light. His mailbox, the admission board, and
even the electronic medical record were there.

In blessed silence, he began his first note, about Mrs. Johnson, an extremely crabby
and belligerent woman with cellulitis. Smiling, he typed, “Mrs. Johnson is
a pleasant 80-year-old woman who presents with pain and redness in her leg.”
He laughed to himself: pleasant, right. Suddenly his pager went off: “Please
see Mrs. Johnson, Room 7Dom 555.” He trudged up there expecting a litany of
complaints, but when he entered her room she was smiling. She hated to disturb him,
but she just wanted to thank him for his kind care and wanted to offer him a home-baked
brownie that her daughter had just dropped off. This was odd, Adam thought. Why was
she so suddenly pleasant?

He went back to his new favorite spot and began another note. Mr. Jackson had chest
pain and an elevated troponin. Dr. Smith was convinced it was unstable angina and
possibly an infarct with an abnormal EKG. But instead, as a kind of test, he wrote,
“Mr. Jackson is admitted with atypical pain, not likely to be ischemia; troponin
and EKG normal.” He ordered a proton-pump inhibitor. Then he went back upstairs
and saw Mr. Jackson again. His repeat troponin was normal, as was his EKG. Adam entered
the room in time to hear a tremendous belch. Mr. Jackson smiled and said he suddenly
felt all better.

That night Adam wrote many admit notes. A patient with a respite admission for metastatic
cancer was now in remission, dementia was only a drug reaction, and a severe case
of calciphylaxis was merely bug bites. He wondered what else he could do.

Adam also opened his stock portfolio on the old computer. If it worked for his patients,
maybe he could do more. Could he write orders for stock purchases for days ago? He
sat there thinking of other ways to make money off this discovery. He barely noticed
the blue light beginning to turn purple. Could he change the outcome of sporting events?
Or even elections?

But before trying this, he had one important task. His co-intern, Moses Jilliard,
was useless. He thought about removing him from the program, but then he had a better
idea. He wrote an evaluation: “Dr. Jilliard is the best intern in the program.
He can do the work of two people. He is well read, caring, and conscientious.”
That ought to do it.

The computer was glowing a more reddish hue now, but Adam was just getting warmed
up. He would change a lot of things. He'd get likes on dating sites, and perhaps a
nice lease on an upscale apartment. He wasn't thinking about patients anymore.

He started an evaluation of himself. “Dr. Smith is perhaps the greatest intern
ever to enter our program. His base of knowledge is at an attending's level. His empathy
and bedside manner are without reproach. His diagnostic acumen is beyond belief.”
But then Adam thought a bit. With a little more time, he could make it much better.
So he deleted the file.

The next day, morning rounds were a pleasure for the resident on the medicine service.
The patients were all doing so well. For some reason all the other services had two
interns and he had only one, but Dr. Jilliard was such a great intern that he didn't
miss having a second one on the team.

Dr. Newman is a hospitalist at Mayo Clinic in Rochester, Minn., and the editorial
advisor and humor columnist for ACP Hospitalist. Find him on Twitter.

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.